2005-05-02 - 1:19 p.m.

Isn't It Romantic?

My thoughts on this later, perhaps. This article definitely provides me with quite a bit of fodder, and I feel it will be important to me to come back to and think about a great deal. It puts into words that to which I've already given a good bit of thought. Essential for archiving.

"Our Romance with Depression"
[Los Angeles Times, May 2, 2005]
By Marianne Szgedy-Maszak, Special to The Times

It was a question that seemed to follow Peter Kramer wherever he went after the success of his bestseller, "Listening to Prozac," 12 years ago.

Although the attentive audiences in bookstores, reading groups, talk shows and conferences generally appreciated his views on depression and psychopharmacology, at a certain point, the question would be asked, typically with a smug smile: "What if Prozac had been available in Van Gogh's time?"

Or Sylvia Plath's? Or Nietzsche's? It doesn't matter; any depressed genius will do, as Kramer writes in his new book "Against Depression," scheduled to arrive in bookstores May 9. "We associate depression with a heroic, artistic stance," he says, "one we think humankind might be worse without."

That attitude, put simply if not clinically, is just nuts, Kramer contends. Assembling evidence from brain imaging, genetic research, biological psychiatry and his own clinical work, Kramer attempts to separate the romance of the depressed genius from the fact that "depression is a serious, progressive disease that we need to treat promptly and effectively and persistently."Kramer, the author of five books and a professor of psychiatry at Brown University in Providence, R.I., recently began a stint as the host of the National Public Radio series "The Infinite Mind." He is perhaps best known for helping transform a small green- and cream-colored antidepressant called Prozac into a celebrity pill and a cultural icon.

Even without his impressive productivity, he might be famous for simply coining the phrase "cosmetic psychopharmacology" � the term he used in "Listening to Prozac" to describe the way the drug "gives a normal person a more socially rewarding personality." He observed that after people took Prozac, their careers or romantic attachments improved, in some cases making them feel "better than well."

And yet, during the intervening years while focusing on the importance of conquering depression, Kramer said he "picked up, among patients and readers, a sort of subtle protective feeling toward depression." A protective feeling exemplified by the inevitable Van Gogh question, in which depression became a kind of muse, evidence of a more refined cast of mind, or of a deeper and more sensitively attuned intellect.

As he pondered the Van Gogh question, Kramer realized that, unlike any other major disease, depression somehow has two distinct identities in our culture: what depression actually is and what it is to us.

What depression is, Kramer said in a recent interview, "is both a disease and a risk factor" that can cause significant disability. Studies show that 16% of Americans will suffer major depression during their lives and the World Health Organization estimates that by 2020, if current trends continue, depression will be second only to heart disease in terms of disability. A number of published studies have pegged the annual workplace cost of depression at $40 billion.

During the last decade, "the clarity with which we see depression has changed radically," Kramer said. New brain science and imaging studies have revealed that not only do depressed brains look different from healthy brains, but that depression is actually a progressive disease; each subsequent depression is more serious, more difficult to get over. When other medical conditions such as diabetes and heart disease are accompanied by depression, the complications can increase the likelihood of greater disability or even death.

And yet, Kramer points out, if we could give pregnant women a vitamin formula so that their children would never suffer from schizophrenia, we would do it without a second thought. "But depression would be more controversial," he said. "Somehow we think that humankind would be worse off without it."

But why?

Because of what depression means to us, Kramer said. "We find ourselves saying that a depression is somehow justified in a way that we would never call a bout of asthma justified, even when the cause is clear," he said. To some, depression has a heroic quality, as well as artistic and intellectual worth. Since the time of the Greeks, our aesthetics, philosophy and literature have elevated the condition to a pinnacle no other emotional state occupies, Kramer said.

Thomas Insell, the director of the National Institute of Mental Health, said Kramer addressed a problem that those in the mental health profession constantly face. "There is the sense that people who are depressed don't have a real problem," he said. "The name for this illness is unfortunate because depression sounds so much like sadness, and it is not sadness. This is a whole-body disease."

Psychiatrists and other mental health professionals can be unwitting accomplices, even though they appreciate the extent of depression more than others. "Like everyone in this culture, I have felt the attractions of depression," Kramer said. "Someone comes in and is bashful and ambivalent and troubled over things that don't trouble other people, and we think that there are some moral qualities, or socially attractive qualities to that stance that we may even prefer to the decisive, more in-control person."

There are serious public health consequences to this dual role of depression. As long as society continues to hold an ambivalent admiration of the disease, Kramer said, it will continue to not be taken seriously � by patients, insurance companies and society. Studies have shown that the combination of antidepressants and some form of talk therapy is the most effective treatment for depression. And yet, insurance carriers often refuse to pay for psychotherapy. If a cancer patient were told that he required chemotherapy and radiation, and the insurance company only agreed to pay for the radiation, what would the reaction be?

"It wouldn't be tolerated," Kramer said. "And that is part of getting depression into the disease category; confronting the medical system. If that is the best treatment, then people ought to have it."

So what if there had been Prozac for Van Gogh, or Nietzsche, or Plath? No one knows. But Kramer points out how revolutionary rethinking this disease might be.

"We've been laboring in the shadow of this illness," he says. "And if we really made headway against it, we might have different tastes in art, we might have different romantic lives and a different sense of what is essential about ourselves and what a fulfilled person really is." He pauses, reflecting on the enormity of those possibilities. "In a way it is taking seriously the notion that the melancholic write philosophy and saying, well then, shouldn't we have a different philosophy?"